| Details | Last Recertification Date | Update | Recertification | 1/31/2024 1:06:17 PM | 2/21/2025 12:35:50 PM | 2/21/2025 12:35 PM |
| Details | Last Recertification Date | Update | Recertification | 2/15/2023 10:21:02 AM | 1/31/2024 1:06:17 PM | 1/31/2024 1:06 PM |
| Contacts | Primary Contact | Update | Change Request | Stewart, Citierra
340 B Program Assistant
Frederiksted Health Care Inc.
3407720260 | Tuitt, Kathleen
Clinical Care Coordinator
Frederiksted Health Care Inc.
3407720260-5314 | 2/15/2023 12:15 PM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2022 10:39:57 AM | 2/15/2023 10:21:02 AM | 2/15/2023 10:21 AM |
| Contacts | Primary Contact | Update | Change Request | Rios, Monica
Director - Division of Social & Community Programs
Frederiksted Health Care, Inc.
3407720260-3242 | Stewart, Citierra
340 B Program Assistant
Frederiksted Health Care Inc.
3407720260 | 2/11/2022 7:28 AM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2021 1:20:43 PM | 2/3/2022 10:39:57 AM | 2/3/2022 10:39 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1164842050 ( ) | | 2/3/2021 1:20 PM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2020 7:17:37 AM | 2/3/2021 1:20:43 PM | 2/3/2021 1:20 PM |
| Contacts | Primary Contact | Update | Recertification | Raymer, Leslie
340B Program Coordinator
Frederiksted Health Care
3407720260-3242 | Rios, Monica
Director - Division of Social & Community Programs
Frederiksted Health Care, Inc.
3407720260-3242 | 2/3/2020 7:17 AM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2019 2:13:52 PM | 2/3/2020 7:17:37 AM | 2/3/2020 7:17 AM |
| Details | Last Recertification Date | Update | Recertification | 2/21/2018 1:21:59 PM | 2/13/2019 2:13:52 PM | 2/13/2019 2:13 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/21/2018 1:21 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 7078 | 2/21/2018 1:21 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | VI | 2/21/2018 1:21 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1164842050 | 2/21/2018 1:21 PM |
| Details | Last Recertification Date | Update | Recertification | 1/25/2017 12:00:00 AM | 2/21/2018 1:21:59 PM | 2/21/2018 1:21 PM |
| Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 2/21/2018 1:21 PM |
| Contacts | Authorizing Official | Update | | Webster, Masserae Sprauve
Chief Executive Officer
3407721992-2132 | Webster, Masserae Sprauve
Chief Executive Officer
Frederiksted Health Care
3407721992-2132 | 2/20/2018 1:20 PM |
| Contacts | Signed By | Update | | Webster, Masserae Sprauve
Chief Executive Officer
3407721992-2132 | Webster, Masserae Sprauve
Chief Executive Officer
Frederiksted Health Care
3407721992-2132 | 2/20/2018 1:20 PM |
| Contacts | Primary Contact | Update | | Raymer, Leslie
340B Program Coordinator
3407720260-3242 | Raymer, Leslie
340B Program Coordinator
Frederiksted Health Care
3407720260-3242 | 2/8/2018 11:27 AM |
| Addresses | Main Address | Insert | | |
6C La Grande Princesses
Christiansted St Croix, VI 00823-0516 | 1/25/2017 10:50 AM |
| Contacts | Primary Contact | Insert | | | Raymer, Leslie
340B Program Coordinator
3407720260-3242 | 1/25/2017 10:50 AM |
| Contacts | Authorizing Official | Insert | | | Webster, Masserae Sprauve
Chief Executive Officer
3407721992-2132 | 1/25/2017 10:50 AM |
| Contacts | Signed By | Insert | | | Webster, Masserae Sprauve
Chief Executive Officer
3407721992-2132 | 1/25/2017 10:50 AM |
| Details | Last Recertification Date | Update | | 2/16/2016 12:00:00 AM | 1/25/2017 12:00:00 AM | 1/25/2017 10:50 AM |
| Details | Last Recertification Date | Update | | 1/28/2015 12:00:00 AM | 2/16/2016 12:00:00 AM | 2/16/2016 8:24 AM |
| Addresses | Shipping Address | Insert | | | Frederiksed Health Care
516 Strand Street
Frederiksted St Croix, VI 00840 | 1/28/2015 9:54 AM |
| Details | Last Recertification Date | Update | | | 1/28/2015 12:00:00 AM | 1/28/2015 9:53 AM |
| Details | Is Authorizing Official EHB Data | Update | | | False | 1/28/2015 9:53 AM |
| Details | 340B ID | Update | | ONLINE_REG | CH025320C | 4/30/2014 2:05 PM |
| Dates | Participating Approval Date | Update | | | 4/30/2014 12:00:00 AM | 4/30/2014 2:05 PM |
| Details | State | Update | | Pending | Active | 4/30/2014 2:05 PM |
| Dates | Start Date | Update | | | 7/1/2014 12:00:00 AM | 4/30/2014 2:05 PM |
| Details | Last Recertification Date | Insert | | | | 4/15/2014 12:49 PM |
| Details | Grant Number | Insert | | | H80CS00372 | 4/15/2014 12:49 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 4/15/2014 12:49 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/15/2014 12:49 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/15/2014 12:49 PM |
| Details | Medicare Provider Number | Insert | | | | 4/15/2014 12:49 PM |
| Details | Entity Name | Insert | | | FREDERIKSTED HEALTH CARE INC | 4/15/2014 12:49 PM |
| Details | Program Code | Insert | | | CH | 4/15/2014 12:49 PM |
| Details | Entity Subname | Insert | | | Frederiksted Health Care, Inc. Northshore Health Center | 4/15/2014 12:49 PM |
| Dates | Participating Approval Date | Insert | | | | 4/15/2014 12:49 PM |
| Details | State | Insert | | | Pending | 4/15/2014 12:49 PM |
| Dates | Registration Date | Insert | | | 4/15/2014 12:00:00 AM | 4/15/2014 12:49 PM |
| Dates | Signed By Date | Insert | | | 4/15/2014 12:00:00 AM | 4/15/2014 12:49 PM |
| Dates | Start Date | Insert | | | | 4/15/2014 12:49 PM |
| Terminations | Termination Comments | Insert | | | | 4/15/2014 12:49 PM |
| Terminations | Termination Date | Insert | | | | 4/15/2014 12:49 PM |
| Terminations | Termination Effective Date | Insert | | | | 4/15/2014 12:49 PM |
| Terminations | Termination Reason | Insert | | | | 4/15/2014 12:49 PM |